Overview

Multiple Sclerosis (MS) is a chronic disease of the central nervous system, which predominantly affects young adults during their most productive years.  Viral and autoimmune etiologies are postulated. Genetic and environmental factors are known to contribute to MS, but a specific cause for this disease is not identified.

Pathologically, MS is characterized by the presence of areas of demyelination and T-cell predominant perivascular inflammation in the brain white matter. Some axons may be spared from these pathological processes.

Disease begins most commonly with acute or subacute onset of neurologic abnormalities. Initial and subsequent symptoms may dramatically vary in their expression and severity over the course of the disease, that usually lasts for many years.

Early symptoms may include:

Ø   numbness and/or paresthesia,

Ø   mono- or paraparesis,

Ø   double vision,

Ø   optic neuritis,

Ø   ataxia, and

Ø   bladder and/or bowel control problems.

Subsequent symptoms also include;

more prominent upper motor neuron signs, i.e.,.

Ø   increased spasticity,

Ø   increasing para- or quardriparesis.

Ø   Vertigo,

Ø   incoordination and

Ø   other cerebellar problems,

Ø   depression,

Ø   emotional lability,

Ø   abnormalities in gait,

Ø   dysarthria,

Ø   fatigue, and

Ø   pain

Ø   are also commonly seen.

Neurological findings, clinical observation, results of Magnetic Resonance Imaging (presence of areas of demyelination in the CNS), spinal fluid examination (presence of oligoclonal bands and/or elevated IgG index) and sometimes tests of evoked potentials constitute the basis for diagnosis.

Differential diagnosis for MS includes other demyelinating diseases of the nervous system, often of a viral or postinfectious origin. Among them are encephalomyelitis, transverse myelitis, as well as other immune-mediated conditions, which affect CNS, such as sarcoidosis, systemic lupus erythematous, Vitamin B-12 deficiency, etc.

MS is classified according to its clinical course into several categories: benign, relapsing-remitting (the most common variant), progressive-relapsing, primary progressive and secondary progressive.

There is no curative treatment available for the MS. However, a number of medications can be used to treat the disease symptomatically. Corticosteroids are medications of choice for treating exacerbations. Interferonß-1B (Betaseron.) as well as Interferonß-1a (Avonex.) are successfully used to reduce the frequency and severity of relapses. Copolymer 1 is now being investigated in clinical trials and also appear to decrease the disease activity. Specific medications are also available to treat fatigue, pain, spasticity, bladder control problems, etc.

In the future, medications aimed at reducing specific autoimmune response, and, possibly, medications designed to assist in remyelination will help improve the quality of life of MS patients.

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